Provider Demographics
NPI:1578889176
Name:READ, KRISTEL RENEE
Entity Type:Individual
Prefix:MRS
First Name:KRISTEL
Middle Name:RENEE
Last Name:READ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KRISTEL
Other - Middle Name:RENEE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6180 BROCKTON AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2228
Mailing Address - Country:US
Mailing Address - Phone:951-788-7080
Mailing Address - Fax:951-788-7075
Practice Address - Street 1:6180 BROCKTON AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2228
Practice Address - Country:US
Practice Address - Phone:951-788-7080
Practice Address - Fax:951-788-7075
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 67718106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist